Panic Attacks, Anxiety, and Uncertainty

Bill WhiteAugust 18, 2009

You’d certainly get no argument from most anyone that we’re living in very uncertain times. Though I suppose that’s been the case since humans graced the planet, it sure appears to be a lead-pipe-cinch these days. I mean, you name it, the economy, unemployment, political unrest, terrorism; the list of uncertainty goes on and on. Now, for many, this business of uncertainty isn’t much of an issue; however, it sure is for an anxiety sufferer. And the good news is there’s a reason.

Research conducted by Dr. Jack Nitschke, a professor of psychiatry and psychology at the University of Wisconsin-Madison, revealed the element of uncertainty can be so powerful that it holds the potential to make an already distressful experience all the more intense and difficult to manage. And this, of course, can have profound negative impact upon social functioning, as well as overall mental, emotional, and physical health. It’s all about emotional response, and as always, it’s driven by the activity of neurons.

So how did Dr. Nitschke make such a discovery? Well, it’s pretty cool, actually. Functional magnetic resonance imaging (fMRI), an imaging technique that’s augmented by its ability to follow blood flow, allowing it to gain a functional perspective, was incorporated to monitor the workings of the brain’s amygdala and insular cortex. The amygdala, located within the temporal lobe, is the very headquarters of our emotion and fear circuitry. The insular cortex, located at the junction of the temporal, parietal, and frontal lobes, is involved with a variety of functions linked to emotion and the maintenance of homeostasis, our body’s sense of internal regulation and equilibrium. Significant among these functions are perception, motor control, self-awareness, cognitive functioning, and overall interpersonal experience. To the point, it’s been said the insular cortex is responsible for what it feels like to be human, as opposed to just another mammal. Interestingly enough, the highly mysterious insular cortex doesn’t traditionally receive much press, but that’s changing as it seems it’s getting a lot of attention within the realm of addiction.

Okay, let’s hit the lab. Dr. Nitschke’s subjects wore goggles that presented a series of images that either symbolized neutrality, like a bed; or symbolized something highly disturbing, say, a seriously injured person. But, before the introduction of each image the subjects were presented with an image that signaled one of three things about the image that would follow. Sort of a tipoff you could say. One such cue was a circle that indicated the coming image would be neutral. Another was an “X” that tipped off the subject the image to come would be disturbing. Finally, a “?” cued what was to come was uncertain.

Well, what do you know? The results showed a much stronger neural response to the disturbing images when they were preceded by the “?,” indicating uncertainty. This, of course, means the amygdala and the insular cortex both responded more vigorously when the element of uncertainty was introduced. Yes, this reaction was much more prolific than when an “X” warned of a coming disturbing image.

After the testing, the subjects were asked how often the “?” was followed by a disturbing image. In spite of reporting they viewed equal numbers of neutral and disturbing images, 75% of them overestimated the frequency of disturbing images that followed the cues of uncertainty. And it makes perfect sense that these overestimations were explained by the brain’s increased response to uncertainty. It seems all the uproar definitely made an impression.

So, this is all well and good, but how can the research be brought alive? Well, to someone who suffers from anxiety the research suggests this whole concept of uncertainty merits much more attention and emphasis within the context of everyday life and therapy. And that’s because if the element of uncertainty can be reduced, overall levels of anxiety and over-the-top reactions to distressful experiences will be reduced in kind.